In the mind or in the brain? Central sensitization in chronic fatigue syndrome

Do you recall patients complaining of hypersensitivity to light, sound, cold, stress or mechanical pressure (e.g. jewellery on the neck)? This often relates to hypersensitivity of the central nervous system, a mechanism referred to as central sensitization. Brain orchestrated inhibitory mechanisms no longer work properly, while the brain activates descending fascilatory pathways. It’s like driving a Ferrari without brakes.

Central sensitization is frequently present in a variety of chronic disorders like fibromyalgia, chronic whiplash associated disorders, osteoarthritis, irritable bowel syndrome and some cases of chronic low back pain. In the late nineties, it was first hypothesized that chronic fatigue syndrome (CFS) is characterized by central sensitization as well.

Many people with CFS feel most comfortable attributing their illness to a disorder of the central nervous system, and this seems to be rational given the cluster of symptoms that occur in the illness. Symptoms like fatigue, non-refreshing sleep, concentration difficulties, impairments in short-term memory, sensitivity to variable stimuli like bright light and chemicals, a decreased load tolerance and widespread pain are suggestive of central nervous system involvement.

In the past ten years, several studies have examined central sensitization in patients with CFS. When all data are studied together, it becomes clear that CFS is characterised by central sensitization [1]. Patients with CFS are hypersensitive for a variety of sensory stimuli, including electrical stimulation, mechanical pressure, heat and histamine. Various tissues respond hypersensitive: the skin, muscle tissue, and the lungs. Central sensitization accounts in part for exercise intolerance in these patients as well.

Thanks to this BiM blog you already know 75% of what is written in the paper. So you can skip the first part of the paper and go directly to the subheading ‘How does central sensitization fit into our overall understanding of CFS?’. Here the fun part begins. That section explains that the presence of central sensitization in CFS is in line with our current understanding of this illness. Central sensitization in CFS corroborates with the presence of several psychological influences on the illness, the presence of infectious agents and immune dysfunctions, and the dysfunctional hypothalamus pituitary adrenal-axis as seen in these severely debilitated patients. This is important for an illness with a long history of disagreement between scientists. A change in thinking towards studying and treating CFS as a central sensitization disorder appears warranted.

About Jo

Jo Nijs holds a PhD in rehabilitation science and physiotherapy. He is a researcher and assistant professor at the Vrije Universiteit Brussel (Brussels, Belgium) and the Artesis University College Antwerp (Belgium), and he is a physiotherapist at the University Hospital Brussels. His research and clinical interests are patients with chronic unexplained pain/fatigue. He has (co-)authored more than 100 peer reviewed publications and served over 40 times as an invited speaker at national and international meetings.

Comments

Do you have any tips on treating the central sensitisation aspects of conditions such as IBS and Chronic Fatigue. I am a physio and use many of your methods to treat CRPS – but don’t have the knowledge (or imagination) to understand how to extrapolate it to these conditions (which has a more personal basis).
Thanks so much for your help.

Are you young with CRPS? We need your help!

Young people with CRPS and parents/caregivers are needed for research being conducted at Bath University

The study involves asking young people (14-25 years) with CRPS and parents of young people with CRPS to complete a 20-25 online survey which asks them to think about their future. Study recruitment is being conducted separately for both young people and parents. Please email crpsstories@bath.ac.uk if you would like to take part. Participants will be paid for their time.

PainAdelaide 2019

For you interstaters / internationallers – it is the day after Womad so combine a trip to the Festival City with one of the world’s truly great music festivals. Put it in your diary and we will let you know as soon as registration is up and running.

It’s impossible to slip your disc!

Lorimer Moseley answering the question “What is the thing that annoys you most when we talk about back pain?”

Online survey on bodily changes, sensations, and mood in people with chronic pain

How do CRPS and other chronic pain conditions affect bodily functions, sensations, and mood? Help CRPS researcher Janet Bultitude find out by responding to her survey.

The survey is aimed at people with CRPS, people with chronic pain conditions other than CRPS, and people without any chronic pain condition. The survey takes approximately 20 minutes and the responses are anonymous.

Prof Paul Hodges on pain and altered movement

Am I safe to move?

Listen to Lorimer Moseley talk to Karim Khan on new understanding of pain and focusing on the patient.

Understanding Pain

Regular physical activity is important for our health and well-being. Recent evidence suggests that independent of being physically active, limiting the duration of sedentary behavior, such as sitting or lying down, is important to reduce the risk for cardiovascular disease, diabetes, cancer and all-cause mortality (Biswas et al. 2015). Advances in wearable sensors provide a […]

We don’t normally have to think about our breathing and that’s because breathing is handled by a subconscious part of the brain called the medulla. The medulla automatically controls our breathing as well as our heart rate and blood pressure (Del Negro et al. 2018). It sends neural signals to the breathing muscles to activate them […]

Got an event or meeting you want to promote?

We might be able to help you spread the word. Tell us in an email,

Who is the convenor?
Who is the contact person?
Where and when is it?
Is it non-profit, an association meeting or a commercial venture?
What is the objective?
Who are you wanting to attend?
Where can people go to find out more?

Then contact Heidi@bodyinmind.org

BiM will no longer have comments

Dear BiM Community
We have come to the difficult decision to stop comments as this feature is no longer serving its intended function for the wider readership of BiM. Our aim is to facilitate and disseminate good clinical science research, the comments section were for folks to engage with this research constructively and not promote individual views or therapies. We feel this function is now not being fulfilled.

Archives

Archives

Looking for information?

We often get people writing in about their particular conditions asking for more information and help. Unfortunately we get too many to be able to respond personally. We do not publish these comments for privacy reasons and we cannot offer treatment advice.

All blog posts should be attributed to their author, not to BodyInMind. That is, BodyInMind wants authors to say what they really think, not what they think BodyInMind thinks they should think. Think about that!

Subscribe!

All blog posts should be attributed to their author, not to BodyInMind. That is, BodyInMind wants authors to say what they really think, not what they think BodyInMind thinks they should think. Think about that!

We aim to facilitate and disseminate good clinical science research. We love comments that engage with the research and are constructive and respectful. We do not prescribe treatments. Promotion of your particular therapy in the comments section is not appropriate here either - that is not the point of BiM. Finally, all the comments that are made reflect the views of the person who made them and are not endorsed by BiM or members of the BiM research group.